Q&A: Query alerts and fatigue

Q: We have a process on the inpatient side of our CDI program to only place three queries on a chart to avoid query fatigue. How do you manage the number of queries/alerts to a primary care provider in the ambulatory space? There may be 10–15 hierarchical condition categories (HCC) that need to be recaptured, and we don’t always know if the patient will be back in the office during the year, so it’s important to get those HCCs addressed during this one annual wellness visit. Do you have a number limit, or do you send all the queries while the opportunity is there?

A: Physician query fatigue is definitely a big concern, especially with burnout levels at an all-time high. There are a couple of different ways you can approach this issue and avoid unnecessary querying while still ensuring the HCC data gets captured.

First, it’s a good idea to coach your CDI team to use their judgment when determining how many queries to send a given provider and when it’s appropriate to do so. Sometimes, you have to pick your battles.

A more nuanced, case-by-case approach will likely serve you better than putting a hard limit on the number of queries CDI professionals are allowed to send at any one time. The risk with a hard limit is that some CDI team members may stick to the rule so stridently that they skip sending queries that are truly warranted because they already hit their “maximum queries” for the chart.

If you have a physician advisor or champion on the outpatient side, you may want to collaborate with them on cases with a long list of potential opportunities for queries to prioritize which to send first. If you’re seeing the same long list of opportunities repeatedly, remember to close the loop with your outpatient providers and provide education on why capturing those diagnoses is important.

Though it may not always be an option, if a patient has multiple appointments already booked in the system, you can work to spread the queries over those visits rather than posing them all at once. This will help keep the queries at a manageable level for each individual patient visit and hopefully limit potential query fatigue.

Depending on your department’s resources, you may also be able to leverage your technology to avoid some of the potential queries in the first place. Implementing an artificial intelligence tool that nudges the provider to document all the patient’s HCCs for the new calendar year can go a long way in limiting excessive queries. The CDI team, of course, can always follow-up with the provider if they ignored a nudge.

Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council.